Matijasic Nusa, Bonevski Aleksandra, Tokic Pivac Visnja, Pavic Ivan
Department of Hematology and Oncology, Children's Hospital Zagreb, Zagreb, Croatia.
Division of Cardiology, Children's Hospital Zagreb, Zagreb, Croatia.
Pediatr Allergy Immunol Pulmonol. 2019 Sep 1;32(3):86-91. doi: 10.1089/ped.2019.0990. Epub 2019 Sep 17.
Impaired lung function has been detected in up to 65% of all childhood cancer survivors. It is often caused by exposure to radiation therapy and various chemotherapeutics. The first cytotoxic drug ever identified as a causative agent of lung injury was busulfan, reported in the early 1960s. Signs and symptoms of busulfan lung are nonspecific and it is therefore difficult to differentiate the condition from pulmonary impairment caused by other pulmotoxic agents, infections, pulmonary metastases, graft-versus-host disease, or other noninfectious post-transplant complications involving the lungs. A case example is provided to illustrate the difficulties in management of busulfan-induced lung injury in children. A retrospective review of cases of busulfan-induced lung injury indexed in PubMed until March 2019 was performed. Inclusion criteria for articles was available in full text in English. Impaired lung function caused by busulfan may become an increasing problem for young survivors. Newly developed dyspnea or subclinical damage detected on pulmonary function tests, indicating primarily restrictive disease, should always arouse suspicion of busulfan-induced lung injury in a child conditioned with busulfan, especially after excluding other leading culprits of pulmonary damage affecting oncology patients.
在所有儿童癌症幸存者中，高达65%的人被检测出肺功能受损。这通常是由放疗和各种化疗药物引起的。20世纪60年代初报道，首个被确定为肺损伤致病因素的细胞毒性药物是白消安。白消安肺的体征和症状不具有特异性，因此很难将其与其他肺毒性药物、感染、肺转移、移植物抗宿主病或其他涉及肺部的非感染性移植后并发症所导致的肺损伤区分开来。本文提供了一个病例，以说明儿童白消安所致肺损伤的管理难点。对截至2019年3月在PubMed上索引的白消安所致肺损伤病例进行了回顾性研究。纳入文章的标准是有英文全文。白消安导致的肺功能受损可能会成为年轻幸存者日益严重的问题。新出现的呼吸困难或肺功能测试中检测到的亚临床损伤，主要提示限制性疾病，在接受白消安治疗的儿童中，尤其是在排除了影响肿瘤患者的其他主要肺损伤原因后，应始终怀疑是白消安所致肺损伤。
